Thursday, August 13, 2015


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Whether anybody likes it or not, the truth is in EM you will be graded mainly on your presentations to attendings. Following on the heels of our discussion of thinking EM, what makes a good EM presentation?

First, brevity. Nobody - absolutely nobody - in the ED wants to listen to even a quarter of a medicine presentation. This isn't just personal preference - there are too many patients with too high of an acuity to waste time. Is the patient nice, personable, have a really cool job? Save it for after the presentation during downtime. Which brings us to:

Keep it relevant to the chief complaint. You'll hear this a lot without much explanation. The truth is this kind of communication is a skill that will become easier as your knowledge increases - how relevant is past surgery to nausea and vomiting? This is complicated by the fact different attendings will consider some things "relevant" that others don't. This will come with experience, but in the meantime, decide for yourself what you think is relevant and present that (but know all the information in case you're asked).

Importantly, remember to ask why they came to the ED today. They may have had a week of abdominal pain, but what caused them to finally call 911? This is something that both students and residents will gloss over, but it is important to know the most proximate reason someone finally presented.

Relevant review of systems, past medical history, past surgical history, and family history should be in your HPI. Always mentioned medications and drug allergies. Always mention vitals, but tailor your physical exam to the complaint.

Last, make sure you have a thought out plan and disposition. These are king in the ED and many attendings will judge your clinical knowledge through these two things.

Practice tips:

1. After you interview the patient, stop and take time to organize your presentation before going to an attending. Actually taking this time is what will separate you from your peers and improve your skills.

2. Commit. Commit to a differential, commit to a plan, commit to your history and physical. Always admit if you don't know something. Being wrong is okay, but don't waffle. By the time you present it's too late for that kind of wishy-washiness anyway - you're not going back to the patient once you start.

3. Ask questions at the end. Asking for feedback can be difficult, but at a minimum ask any questions you have about the patient's presentation or treatment. It's not assumed you know everything, and this is the only way to improve your future presentations.

Further reading:

Below are two papers that go more in depth about oral presentations in the ED, and systems a student can use to get a better grasp on them.

1 comment:

  1. I totally agree. a thought plan is so important in ED. and thanks for sharing such a wonderful tips about how you can commit and prepare yourself for asking the relevant questions.